PancreasPancreatic anastomosis after pancreatoduodenectomy: A position statement by the International Study Group of Pancreatic Surgery (ISGPS)
Section snippets
Methods
In order to formulate a position statement on the optimum method of PA that should be performed after PD, an extensive search strategy was adapted to identify relevant studies and meta-analyses in PubMed and Cochrane databases (Fig). Only articles relevant to PA with English-language abstracts and those published from January 1995 until December 2015 were included. Medical subject headings and keywords included pancreatoduodenectomy, pancreaticoduodenectomy, pancreaticojejunostomy,
Pancreaticojejunostomy (PJ)
The various techniques of pancreaticojejunal anastomosis include end-to-side invagination, duct-to-mucosa, and the “binding technique” using a single- or double-layer technique.7, 8 Many nonrandomized studies have suggested that a duct-to-mucosa anastomosis is associated with a lower POPF rate compared to an invagination anastomosis; most of these studies, however, are observational with fistula rates up to 20%,9 and the definition of a POPF was not consistent.
A duct-to-mucosa anastomosis can
Discussion
In this era of evidence-based medicine, pancreatic surgeons over the past 2 decades have rightly embarked on the mission of identifying the ideal method of pancreatico-enteric reconstruction after PD. Despite multiple randomized studies and meta-analyses, there is no clear evidence or universally accepted guidelines for how to construct the optimal PA after PD. During the past 2 decades, although the operative mortality has decreased dramatically, the overall morbidity remains high (about 50%),
Position statement
In conclusion, the position statement of the ISGPS on pancreatic anastomosis after PD is as follows (based on Table III):
- (1)
Neither the use of pancreaticogastrostomy nor pancreaticojejunostomy has been shown to result in any substantial difference in the incidence of CR-POPF rates after a pancreatico-enteric anastomosis.
- (2)
A consistent practice of a standardized technique may be a potential strategy to decrease the rate of CR-POPFs for surgeons early in their career, but experienced surgeons at
References (82)
- et al.
Postoperative pancreatic fistula: an international study group (ISGPF) definition
Surgery
(2005) - et al.
The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula : 11 years after
Surgery
(2017) - et al.
GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations
J Clin Epidemiol
(2013) - et al.
Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial
Surgery
(2003) - et al.
Duct-to-mucosa vs invagination for pancreaticojejunostomy after pancreaticoduodenectomy: a prospective, randomized controlled trial from a single surgeon
J Am Coll Surg
(2016) - et al.
Peng's binding pancreaticojejunostomy after pancreaticoduodenectomy. An Italian, prospective, dual-institution study
Pancreatology
(2013) - et al.
Is Peng's pancreaticojejunal anastomosis more effective than mucosa-mucosa anastomosis in duodenopancreatectomy for pancreatic and peri-ampullary tumours?
Cir Esp
(2013) - et al.
Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure
J Am Coll Surg
(2002) - et al.
Pancreaticojejunostomy after pancreaticoduodenectomy: suture material and incidence of post-operative pancreatic fistula
Pancreatology
(2016) - et al.
Pancreaticogastrostomy: clinical experience with a direct pancreatic-duct-to-gastric-mucosa anastomoses
Am J Surg
(1984)
Predictive factors for exocrine pancreatic insufficiency after pancreatoduodenectomy with pancreaticogastrostomy
J Gastrointest Surg
A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreaticoduodenectomy
Am J Surg
Randomized controlled single-center trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy
J Gastrointest Surg
Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial
Lancet Oncol
Isolated Roux loop pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a prospective randomized study
HPB (Oxford)
Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis
Am J Surg
Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials
J Gastrointest Surg
The impact of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction on pancreatic fistula after pancreaticoduodenectomy: meta-analysis of randomized controlled trials
HPB (Oxford)
Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials
Am J Surg
The pancreaticojejunal anastomotic stent: friend or foe?
Surgery
Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial
J Gastrointest Surg
Role of octreotide in the prevention of postoperative complications following pancreatic resection
Am J Surg
Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial
Surgery
Prospective randomized trial of the effect of octreotide on pancreatic juice output after pancreaticoduodenectomy in relation to histological diagnosis, duct size and leakage
HPB (Oxford)
The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial
J Am Coll Surg
Pancreatic resection: drain or no drain?
Surgery
Drain management following pancreatoduodenectomy: reappraisal of a prospective, randomized trial using risk stratification
J Am Coll Surg
Use of the round ligament of the liver to decrease pancreatic fistulas: a novel technique
J Am Coll Surg
A prospectively validated risk score accurately predicts pancreatic fistula after pancreatoduodenectomy
J Am Coll Surg
Clinical risk score to predict pancreatic fistula after pancreatoduodenectomy: independent external validation for open and laparoscopic approaches
J Am Coll Surg
Evaluation of a recently described risk classification scheme for pancreatic fistulae development after pancreaticoduodenectomy without routine post-operative drainage
HPB (Oxford)
Prophylactic octreotide for pancreatoduodenectomy: more harm than good?
HPB (Oxford)
Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial
Lancet
Defining the practice of pancreatoduodenectomy around the world
HPB (Oxford)
Pancreatic anastomotic leak after the Whipple procedure is reduced using the surgical microscope
Surgery
Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy
Arch Surg
Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation
Ann Surg
Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume
Ann Surg
Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial
J Am Coll Surg
Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial
Ann Surg
Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy
Arch Surg
Cited by (172)
“2 + 3” pancreaticojejunostomy: A novel duct-to-mucosa anastomosis
2024, Asian Journal of SurgeryPrediction of complications associated with general surgery using a Bayesian network
2023, Surgery (United States)Pancreatic cancer
2023, European Journal of Surgical Oncology